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Monday, July 21, 2014

Healthcare pie: Rs 5,000 for a bureaucrat or politician; Rs 180 for villager

NEW DELHI: When it comes to healthcare, some
are more equal than others for the government. Under the Central Government
Health Scheme (CGHS) which covers central government employees, including
serving and retired babus, current and ex-members of Parliament and the
judiciary, the annual per capita expenditure is more than Rs 5,000. In
contrast, the National Rural Health Mission (NRHM), which caters to the rural
masses, spends just Rs 180 per head.

The CGHS is financed mainly through the Centre's tax revenues. Though
beneficiaries do contribute a share of their wages towards premium, ranging
from Rs 600 to Rs 6,000 a year depending on their pay scale, this accounts for
just about 5 per cent of the total expenditure. The government shells out the
remaining 95 per cent.

As of 2012-13, CGHS had 10.3 lakh card holders with a beneficiary base of 33.6
lakh (including family members) and spent more than Rs 1,600 crore to cover
them. Almost 40 per cent of the cardholders are in Delhi and exhaust 60 per cent of the CGHS
budget, followed by 8 per cent in Kolkata who consume about 4 per cent of the
CGHS budget.

No cash limit for CGHS cardholders

Critics point out that the presence of an exclusive scheme like CGHS to fulfil
the health needs of the country's decision-makers and their families could be
one reason why there is so little enthusiasm or urgency in the government to
curb rising healthcare costs.

While most publicly funded health
coverage schemes, including the Rashtriya Swasthya Bima Yojana (Rs 30,000 per
family per year) or Andhra Pradesh's Rajiv Aarogyasri (about Rs 2 lakh per
family per year) and Tamil Nadu's Kalaignar scheme (Rs 1 lakh over four years
per family) have a limit on the expenses they will cover, CGHS has no such
limits.

The Employee State Insurance Scheme (ESIS), meant for workers of all
establishments employing more than 10 people, has no cash limit either, but the
per capita expenditure on its beneficiaries is just Rs 379. The ESIS covers 5.6
crore people, including workers and their families. CGHS and ESIS are the only
insurance schemes that provide comprehensive healthcare coverage, including
outpatient care, preventive/wellness care and hospitalization.

A Planning Commission report of
January 2011 titled "A Critical Assessment of the Existing Health
Insurance Models in India"
noted that ESIS was probably managing to keep costs down because it relied
heavily on its own facilities in most cases. CGHS, on the other hand, provided
100 per cent inpatient care through a private network of hospitals and was
driven by high-end tertiary care provided largely by big corporate hospitals.

The CGHS also had the highest hospitalization rate among the state-funded insurance
schemes (22 per 1,000 beneficiaries). Though this was lower than that of
private insurance (64 per 1,000 beneficiaries), the average hospitalization
expenditure per beneficiary was the highest under CGHS, higher than even the
commercial insurers. And though central government-funded hospitals, including
premier ones like AIIMS, are available to beneficiaries, a majority them chose
corporate hospitals.

"In CGHS, a few million
people are being given huge benefits. One of the big drivers of cost under CGHS
is prescription drugs," pointed out a public health expert. "While
the central government promotes generic drugs for all government facilities and
schemes, a look at the list of drugs procured by CGHS reveals that for its own
employees it buys mostly branded generics and patented drugs, which are very
expensive and drive up average health expenditure."

There is also a total lack of transparency on how the CGHS operates. "The
CGHS collects information on coverage, infrastructure and utilization of its
dispensaries but it does not publish the same. It neither reports financial nor
any other type of performance publicly," pointed out the Planning
Commission report. Unlike other publicly funded insurance schemes, even the
claims ratio is not available for CGHS.